The educational, employment and recreational opportunities available locally to South African adolescents are associated with their sexual behavior, although not always in expected directions or in the same way for males and females, according to a population-based survey in one province.1 For example, the higher the average wages of adolescents in the community or their level of participation in schooling or sports, the less likely adolescent women were to have had sex in the past year (odds ratios, 0.01-0.6), but the same was not true for adolescent men. Adolescent women's likelihood of condom use at last sex was positively associated with average wages in the community (1.6); however, for adolescent men, the higher the community levels of participation in schooling, work or sports, the lower the odds of use (0.01-0.2).
Researchers interviewed a representative sample of 14-22-year-olds residing in two districts of KwaZulu-Natal Province in 1999. Respondents were asked about their sexual behavior, their education and work experiences, their participation in extracurricular activities (classified as youth programs, sports or religious clubs) and their households. Communities were selected from among census areas, and data for each were obtained by aggregating the individual data from respondents living there. Using logit analysis, the researchers examined associations of individual, household and community factors with two measures of sexual behavior - sex in the past year and use of a condom at last sex in the past year (defined as use at last sex with all of the most recent partners mentioned, up to three). Separate analyses were conducted for males and females.
Analyses were based on 2,992 respondents living in 109 communities. Fifty-six percent of respondents were blacks living in urban areas, and 24% rural blacks; the rest were Indians (14%) or whites (6%). Roughly half of respondents each were female (55%) and 16-19 years old (51%). The majority (74%) were in school; only 10% were working. Modest proportions participated in each of the three extracurricular activities (16-30%). Fifty-eight percent of respondents lived in permanent houses (a measure of household economic status), and 47% had an adult who had at least 12 years of schooling in their household.
On average, 66% of adolescents in each community were in school, but only 7% of those aged 20 or older had completed secondary school. Across communities, an average of 12% of adolescents were working, and their mean wage was about 200 rand (roughly US$30) per week. Levels of participation in extracurricular activities averaged 15-28%.
Overall, 47% of respondents reported having had sexual intercourse in the past year. In analyses including only individual and household factors, the odds of adolescent women's having had sex in the past year were lower for Indians than for whites (odds ratio, 0.2), for women in school than for their out-of-school counterparts (0.2) and for women who had an adult with at least a secondary education in their household than for others (0.6). The odds were higher for 16-19-year-olds and 20-22-year-olds than for 14-15-year-olds (9.3 and 27.6) and for women participating in youth programs than for those not participating in any extracurricular activities (1.9).
When community factors were added to the analysis, these associations remained about the same, and living in a house made of traditional materials, rather than a permanent house, was associated with reduced odds of recent sexual activity (odds ratio, 0.6). In addition, adolescent women's likelihood of having had sex was negatively associated with the proportion of their peers who were in school or had a secondary education (0.01-.03), community wages (0.6) and levels of participation in sports (0.2).
Among adolescent men, when only individual and household factors were considered, respondents currently in school had reduced odds of having had sex in the past year (odds ratio, 0.4). The odds of recent sex were higher for urban- and rural-dwelling blacks than for whites (4.3 and 4.1), for 16-19-year-olds and 20-22-year-olds than for 14-15-year-olds (10.9 and 29.9), for men who were working than for those who were not (3.0) and for men participating in sports than for those not involved in any activities (2.3). When community factors were also taken into account, these associations, with the exception of that for rural-dwelling black men, remained significant. No community factors were associated with having had sex in the past year.
Of respondents who had had sex in the past year, 47% had used a condom at last sex. Among adolescent women, when only individual and household factors were included in the analysis, the likelihood of condom use was reduced for respondents living in a house made of traditional materials (odds ratio, 0.5) and was elevated for women whose household included an adult with 12 or more years of schooling (1.6). After addition of community factors, only household education remained significantly associated with condom use at last sex. In addition, the higher the community's average wage, the greater the likelihood of condom use (1.6).
Among adolescent men, when only individual and household factors were considered, the likelihood of condom use at last sex was positively associated with working (odds ratio, 2.1) and with household education (2.1). When community factors were added to the analysis, these associations persisted; furthermore, use was reduced among urban- and rural-dwelling blacks (0.1 for each). In addition, condom use was negatively associated with the proportion of adolescents in a community who were in school or had a secondary education (0.01-0.04), were working (0.01) or were participating in sports (0.2).
The researchers comment that prospects for education and employment "shape young people's future plans and expectations," which may in turn affect their decisions about sexual risk-taking. The observed associations between community opportunities and adolescents' sexual behavior may aid the design of interventions to promote safer sex, they note; importantly, such interventions will likely have to be tailored for women and for men. The findings, they conclude, "should encourage researchers studying HIV/AIDS, particularly in high-prevalence settings such as South Africa, to consider a wide range of influences on adolescents' lives, because the context in which adolescents face decisions may be critical to their sexual behaviors."
1. Kaufman CE et al., Communities, opportunities, and adolescents' sexual behavior in KwaZulu-Natal, South Africa, Studies in Family Planning, 2004, 35(4):261-274.